1,721,278 research outputs found
Laparoscopic para-aortic lymphadenectomy in cases of retro-aortic left renal vein
No full textVascular anomalies involving the renal veins are rare;
the overall prevalence for a retro- aortic renal vein is
3%.
A patient diagnosed with serous ovarian cancer
underwent a laparoscopic surgical restaging,
including hysterectomy, omentectomy, peritoneal
biopsies, bilateral pelvic lymphadenectomy, and para-aortic
lymphadenectomy. After identification of the
right ureter, inferior vena cava, and aorta, the para-caval
lymph node dissection was completed. The left
lumbo- aortic retroperitoneal spaces were dissected,
but the left renal vein was not found while the left renal
artery was identified. Further inspection revealed the
retro- aortic left renal vein (Figures 1 and 2). The vein
converged into the inferior vena cava after passing
under the abdominal aorta immediately above the
common iliac vein bifurcation. No other vascular
anomalies were found . The surgery was uneventful.
An accurate identification of the renal vessels is
crucial when performing surgical procedures around the inferior vena cava due to the significant risk of vascular injury in
cases of vascular anomalies
Laparoscopic radical hysterectomy for malignant indications: Laparoscopic trachelectomy
No full textCervical cancer is the third most common female cancer and the fourth leading cause of female cancer death worldwide [1]. Approximately 15 % of all cervical cancers are diagnosed in women under the age of 40 years who wish to preserve their fertility [2, 3]. For these reasons, although radical hysterectomy with lymph node dissection represents the standard treatment for early-stage cervical cancer, alternative surgical approaches able to spare reproductive organs have been develope
Peritoneal sarcomatosis 5 years after laparoscopic morcellation of uterine leiomyoma
No full textIn 2011, a 40-year-old woman underwent laparoscopic myomectomy with intraabdominal morcellation. Histology report showed leiomyoma without atypia, necrosis, or mitosis. In 2016, she complained of left lower quadrant pain; ultrasound examination revealed a left hypogastric mass in the site of trocar placement. Percutaneous biopsy results showed a low-grade endometrial stromal sarcoma (LGESS). At laparoscopy, we observed: multiple nodules on uterine serosa, left annex, vesical peritoneum (Figure 1), Douglas pouch (Supplementary Video1), previous left pelvic trocar site (Figure 2), greater omentum (Figure 3), and right/left diaphragm
Laparoscopic total mesometrial resection (L-TMMR)
No full textAbdominal radical hysterectomy and pelvic lymph node dis- section as introduced by Wertheim and Meigs [1–2] first in the beginning of the century is still regarded as “gold stan- dard” in the surgical treatment of the uterine cervix carci- noma, FIGO stages IA2-IB and IIA. The resection of the parametrial and paracervical tissues proposed by the conventional radical hysterectomy is based on a “centrifu- gal diffusion” from the center of the tumor on the direction of the parametrial (dorsal, lateral and ventral) highways. This imply a classic functional and ligament-focused view of the surgical anatomy
Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up
No full textStudy Objective: Beside the pain, there are 2 further problems in the management of endometriosis: the high recurrence rate (10% per year) and the high rate of impaired fertility. The objective of this study was to investigate the pathogenesis of these 2 factors. Design: This is a retrospective cohort study, and the aim is to evaluate the complete excision of endometriotic lesions, including the posterior compartment of the peritoneum, with regard to postoperative outcome, focusing on relieving pain, increasing fertility rate, and decreasing recurrence rate. Setting: Charité-University Clinic, Department of Gynaecology, Endometriosis research Centre. Patients: Fifty-four patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (revised American Society for Reproductive Medicine [rASRM] I = 3; II = 15; III = 10; and IV = 26). Interventions: Posterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as part of a complex surgery: complete excision of endometriosis. Measurements and Main Results: Postoperative outcomes were evaluated, based on the postoperative follow-up (up to 5 years) of 54 investigated patients. In 36 women (66%) preoperative complaints were eliminated. Furthermore, of 28 women seeking improved fertility, pregnancy was reported in 13 cases (46%). In 7 (54%) cases pregnancy occurred spontaneously, and in the remainder with assisted fertilization. In addition, long-term follow-up demonstrated a recurrence rate in 1.8% of patients. Conclusion: Overall, the number of complaints was significantly reduced. Only in the case of reproductive-aged women with ongoing postoperative complaints was it important to preserve the uterus. Although this pilot study on systematic posterior peritonectomy showed improvement in recurrence and fertility rate, the main question remains: will this surgical technique achieve better results and outcomes in the future? This has to be addressed in a prospective randomized study
Sexual, bladder and bowel function following different minimally invasive techniques of radical hysterectomy in patients with early-stage cervical cancer
No full textPurpose: Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer. Methods: From 2007–2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63). Results: Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores. Conclusion: Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively
Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis
No full textIntroduction: Deep infiltrating endometriosis (DIE) affects between 3.8% and 37% of all endometriosis patients, mostly affecting rectovaginal septum or retrocervical space and characterized by the severe endometriosis-related complaints. Nowadays, generally managed with surgery. However, this is associated with a risk of postoperative complications. To better evaluate intra- and postoperative complications and outcomes for rectovaginal (RVE) and retrocervical endometriosis (RCE), the preoperative management should be accurately described and compared. Methodology: This is a cohort retrospective study performed at the Endometriosis Centre of Charité-University Clinic, Berlin. 34 patients were investigated in their reproductive age, n = 19 with RVE and n = 15 RCE, operated between 2011 and 2015. The surgical approach was divergent in both groups. Single laparoscopy was performed in RCE patients (RCEP) and vaginal assisted laparoscopy in RVE patients (RVEP). Long-term postoperative outcome included complications, fertility rate and recurrence rate. Results: The median follow-up time was three years (y). Symptom-free status was revealed in n = 12 RVEP and n = 9 RCEP. Postoperatively, endometriosis-related complaints were presented in n = 7 RVEP and n = 6 RCEP, but with significant pain relief. From n = 8 RVE patients seeking fertility, pregnancy occurred in n = 7 and from n = 9 RCEP pregnancy appeared in n = 5 patients in the meantime of 6 months. Postoperative complications were reported in n = 1 RVEP with early postoperative bleeding, after ureter leakage and n = 1 RCEP with postoperative anastomotic insufficiency. The postoperative recurrence rate was equivalent to zero. Conclusion: The appropriate surgical approach for each group, preserving anatomy and functionality of the organs, seems to be very essential and efficient
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